Re-visiting pacifiers and breastfeeding

A newly published study in Pediatrics is receiving media attention due to its finding that “restricting pacifier distribution during the newborn hospitalization without also restricting access to formula was associated with decreased exclusive breastfeeding, increased supplemental formula feeding, and increased exclusive formula feeding.”

The study took place in a US hospital’s mother-baby-unit (MBU) before and after implementation of a new institutional policy restricting routine pacifier distribution as part of a breastfeeding support initiative. (The four other breastfeeding support measures adopted by the MBU included breastfeeding in the first hour after birth, feeding only breast milk in the hospital, keeping infant in same room with mother in the hospital, and giving mother a telephone number to call for help with breastfeeding after discharge.) Of note, pacifiers were stored in a locked supply management system as part of the new policy, but formula access was not limited in the same way.

The researchers retrospectively examined exclusive breastfeeding rates (as compared to breastfeeding plus supplemental formula, and exclusive formula feeding) before and after the change. They saw a significant decrease in exclusive breastfeeding (from 79% to 68%) paralleled by significant increases in both formula-supplemented breastfeeding (18% to 28%) and exclusive formula feeding (1.8% to 3.4%).

While it is tempting to conclude “thus pacifier use is necessary in supporting exclusive breastfeeding”, it’s also important to note that the study in question states that “no specific script was instituted to verbally instruct parents on infant soothing techniques” either before or after restricting pacifier use. Thus it is equally tempting to conclude that desperate parents will resort to culturally familiar ways to soothe crying newborns — and in US culture, those include bottles and pacifiers.

It would be interesting to see a similar study conducted in a setting that emphasizes supporting parents in learning alternative ways to comfort their babies, such as skin-to-skin care and cue-based breastfeeding. It might also be interesting to see weight loss at discharge, and/or jaundice requiring phototherapy, as an outcome measure.

One Response

Yes, the conclusion is drawn within the context of a culture lacking in knowledge of skin to skin and holding practices for newborns. It would also be interesting to see the incidence of engorgement and latching difficulties in the first week, before and after pacifiers were removed, in both the mothers who did or didn’t supplement with formula.